Acute Coronary Syndrome

Study Objectives:

  • Differentiate between NSTEMI and STEMI in terms of pathophysiology, clinical presentation, and ECG findings.
  • Describe the initial management of ACS, including pharmacotherapy and indications for invasive strategies.
  • Discuss the principles of risk stratification and secondary prevention measures following an ACS event.
  • Review the current guidelines on the management of NSTEMI and STEMI.

Study Outline:

Acute coronary syndrome (ACS) includes unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), all associated with acute myocardial ischemia.

Management and diagnosis of ACS necessitate an understanding of its clinical presentation, epidemiology, pathophysiology, and evidence-based treatment approaches.

Clinical Presentation:

– Common symptoms: chest pain (pressure, tightness, squeezing sensation), possibly radiating to arms, neck, jaw, or back.

– Other symptoms: dyspnea, nausea, vomiting, diaphoresis, syncope.

– Atypical presentations: epigastric discomfort, unexplained fatigue, shortness of breath, especially in elderly, women, and diabetics.

Epidemiology and Pathophysiology:

– ACS is a major cause of morbidity and mortality globally.

– Risk factors: age, male sex, hypertension, dyslipidemia, diabetes, smoking, obesity, family history of coronary artery disease.

– Pathophysiology involves atherosclerotic plaque rupture or erosion, leading to thrombus formation and artery occlusion, causing myocardial ischemia and necrosis.

Clinical History and Examination:

– Focus on chest pain characteristics, duration, precipitating factors, and associated symptoms.

– Assess hemodynamic stability, heart rate, blood pressure, signs of heart failure or cardiogenic shock, cardiac murmurs, and pulmonary edema.

Differential Diagnosis:

– Includes pericarditis, aortic dissection, pulmonary embolism, esophageal disorders, musculoskeletal pain.


– Initial tests: 12-lead ECG (may show ST-segment elevation, T-wave inversion, new left bundle branch block), cardiac biomarkers (troponins).

– Additional tests: chest X-ray, echocardiography, coronary angiography (if needed).


– Pharmacologic therapy: antiplatelet agents (aspirin, P2Y12 inhibitors), anticoagulants (heparin, low molecular weight heparin), beta-blockers, ACE inhibitors, statins.

– Invasive strategies: percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), based on clinical risk scores, patient characteristics, and coronary artery disease extent.

Complications and Preventative Strategies:

– Complications: arrhythmias, heart failure, recurrent ischemia, bleeding from anticoagulation.

– Preventive strategies: control of risk factors, lifestyle modifications, adherence to secondary prevention medications.

For further reading and references, refer to the Cardiology Course (under Materials).


Share via
Scroll to Top
Send this to a friend